BACKGROUND:High turnover among Irish nurses remains a persistent workforce challenge, creating the need to better understand the factors that shape nurses' intentions to leave. Against this backdrop, this paper examines the predictors of turnover intentions within the Irish nursing workforce. PUROPSE:Using an ecosystem organizing model, we analyze how individual nurse characteristics, job-related variables, and organizational factors interact to shape a nurse's turnover intentions. DESIGN:A cross-sectional questionnaire-based study across a large public hospital group in Ireland. METHOD:Data collection took place between September and October 2022 across five different hospital sites, with 263 qualified nurses completing the survey. Turnover intentions were measured using Roodt's Turnover Intention Scale. Linear regression models were constructed controlling for individual characteristics (age, level of employment, length of service, and domestically vs. internationally trained nurses), job-related variables (job satisfaction and employee engagement), and organizational factors (organizational commitment, organizational citizenship, shared leadership, and hospital size). DISCUSSION:Bivariate analysis showed significant correlations between turnover intentions and job satisfaction, organizational commitment, employee engagement, shared leadership, and organizational citizenship behavior. In the fully adjusted model job satisfaction (β=-1.65,p<.001), organizational commitment (β=-1.33,p<.001), shared leadership (β=-0.98,p<.01) and hospital size (β=1.35,p<.01) demonstrated the strongest associations with turnover intentions. CONCLUSION:The use of an ecosystem organizing model sheds light on individual, job, and organizational factors that jointly shape turnover intentions, highlighting key predictors that should inform targeted retention strategies to support a more sustainable nursing workforce.
BACKGROUND:Nursing remains one of the most gender-segregated professions worldwide, with men historically underrepresented. Workforce initiatives increasingly aim to diversify the profession by increasing the representation of men in nursing, yet the implications of greater male representation for workforce sustainability, patient outcomes, and sociocultural change remain unclear. PURPOSE:To systematically synthesize quantitative evidence concerning men in nursing across workforce, patient-related, and sociocultural domains. METHODS:A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DISCUSSION:The findings suggest that greater representation of men in nursing does not necessarily translate into equitable workforce experiences or uniformly improved outcomes. Interpreted through Gendered Organizations Theory, the observed patterns may reflect the influence of organizational structures, workplace interactions, and sociocultural expectations on how men are positioned and supported within nursing. These findings highlight the need to consider representation together with equitable integration, retention, and patient experience. CONCLUSION:Evidence concerning men in nursing revealed varied workforce, patient-related, and sociocultural patterns across contexts. The findings suggest that numerical representation alone may be insufficient to address workforce inequities without attention to organizational structures, workplace interactions, and broader sociocultural norms. REGISTRATION:Retrospectively registered in PROSPERO (CRD420261309048) on 15 February 2026, after the database search was conducted on 30 June 2025.
BACKGROUND:Advances in genetics and genomics have transformed healthcare, requiring nurses to competently integrate genetic information into clinical practice. However, global evidence on nurses' knowledge, attitudes, and practices (KAP) remains fragmented. METHODS:A systematic review and meta-analysis were conducted following standardized guidelines. Multiple electronic databases were searched to identify cross-sectional studies assessing nurses' KAP related to genetics and genomics. Fifty-five studies were included in the systematic review, with 44 eligible for quantitative synthesis. Pooled prevalence estimates were calculated using random-effects models. Subgroup and meta-regression analyses were performed to explore heterogeneity. RESULTS:The pooled event rate for good genetic knowledge among nurses was 27% (95% CI: 18%-38%), indicating limited competency. In contrast, the pooled prevalence of positive attitudes toward genetics was 71% (95% CI: 63%-77%), reflecting high attitudinal readiness. The pooled prevalence of genetics-related clinical practice was 47% (95% CI: 37%-57%), suggesting moderate implementation. Substantial heterogeneity was observed across outcomes. Subgroup and meta-regression analyses indicated that postgraduate education and regional context were associated with higher knowledge levels. CONCLUSION:Despite generally positive attitudes, significant gaps in genetic knowledge and clinical practice persist among nurses globally. These findings highlight the need for strengthened genomic education alongside organizational and policy-level interventions to translate positive attitudes into routine genomics-informed nursing practice.
BACKGROUND:Prescribed burns sustain the fire-adapted forests of the Missouri Ozarks, and the smoke they generate carries respiratory and cardiovascular risks that fall unevenly across rural communities. Little evidence describes how these communities understand or respond to that smoke, leaving nurses in rural settings with limited guidance. PURPOSE:The purpose of this study is to explore how rural community leaders perceive the effects of prescribed burn smoke on community health and well-being in the Missouri Ozarks. METHODS:In this qualitative descriptive study, we conducted semi-structured interviews with 19 rural leaders, from government and public agencies, private foundations, private landowners, and news media, in and around the Mark Twain National Forest between May and September 2024. Interviews were audio-recorded, transcribed verbatim, and analyzed using a codebook (team-based) thematic analysis. DISCUSSION:Three themes emerged. In Smoke Trade-Off, leaders weighed the ecological necessity of burning against smoke-related health burdens they saw as heaviest for children, older adults, and people with respiratory conditions. In Cultural Lens, leaders described tradition, occupational norms, and an ethic of self-reliance as shaping how residents and workers interpreted and responded to smoke. In Trust Currency, leaders described trust, rooted in local history, credible messengers, and face-to-face relationships, as the decisive factor in whether communities accepted burns and protective guidance. In leaders' accounts, protecting rural communities from burn smoke depended more on culturally grounded, trusted communication than on new technical information. CONCLUSION:Nurses can contribute through occupational symptom screening, patient education delivered via trusted local channels, and advocacy for air-quality monitoring and equitable burn planning.
Background The mental capability of nursing staff to provide care during future pandemics, their post-COVID-19 mental health, and their preferences for psychosocial support during pandemics are important considerations for pandemic preparedness. Purpose To examine nursing staff’s perceived mental capability to provide care during future pandemics, their mental health post-COVID-19, and preferences for psychosocial support during pandemics. Methods From March to June 2024, 679 Dutch nursing staff across healthcare sectors completed an online survey. Descriptive and non-parametric statistics examined outcomes and associations. This study adhered to the STROBE guidelines. Discussion Most (90.4%) felt mentally capable of providing care during a future pandemic, with no associations found for demographics, work characteristics, COVID-19 patient care, or redeployment. Mental health was generally good (median Mental Health Inventory-5: 84) and positively associated with higher perceived mental capability to work during a future pandemic. Nursing staff preferred peer-based support (e.g., group conversations with colleagues, moral case deliberations, and pairing up with a colleague during work), followed by one-on-one conversations with a coach and lessons on stress management. Key support topics included workload challenges, witnessing patient suffering, and patient loneliness. Conclusion This study addresses the lack of prospective research on nursing staff’s perceived mental capability to provide care during future pandemics, as well as their mental health and support preferences. While nursing staff reported high mental capability to provide care in a future pandemic and good mental health, various forms and topics for psychosocial support are considered beneficial. The results underscore the necessity of a varied and layered psychosocial support system that is aligned with nursing staff’s preferences and rapidly deployable in future pandemics.
BACKGROUND:Although advance care planning improves end-of-life care, participation is low. For dementia, attitudes must be studied by disease stage to capture changes and better understand patient engagement. PURPOSE:To explore how people with mild-to-moderate dementia described their attitudes toward advance care planning following diagnosis, during disease progression, and when anticipating advanced dementia and end-of-life circumstances. METHODS:This qualitative study used maximum variation purposive sampling to recruit 18 people with dementia from the neurology department of a tertiary hospital in Northeastern China. Data were analyzed using Braun and Clarke's thematic analysis. DISCUSSION:In the early stage of the disease, patients generally held a negative attitude toward future planning, focusing on their current quality of life rather than future uncertainties, and denying the importance of advance care planning. As the disease progressed, they regarded the ability to live normally as the core of a dignified life. However, they made future decisions more out of concern for their children than for themselves, often expressing wishes with restraint and showing hesitation toward participating in advance care planning. When anticipating advanced dementia and end-of-life circumstances, faced with physical decline and limited external support, many patients felt that while advance care planning could help express personal wishes, such plans were unlikely to be meaningfully realized without adequate support systems, leading them to adopt a passive attitude of "letting nature take its course." CONCLUSION:These findings provide a basis for developing stage-specific and culturally sensitive advance care planning interventions.
BACKGROUND:Mentorship is a strategic approach to developing research leadership and professional growth among early-career nurses, particularly in cardiovascular settings where complex clinical and academic demands intersect. PURPOSE:This case study examined a formal, cross-cultural mentoring experience within the Association of Cardiovascular Nursing & Allied Professions (ACNAP) One-to-One Mentorship Program, focusing on its contribution to research leadership development, professional identity formation, and global collaboration in cardiovascular nursing. METHODS:A 12-month narrative case study design was used to explore a mentorship between an early-career cardiovascular nurse researcher in a Middle Eastern country and a senior cardiovascular nursing leader in a European country. Data sources included structured narrative reflections, mentorship plans, meeting records, co-authored scholarly outputs, and personal reflections. DISCUSSION:The mentorship led to the development and submission of a peer-reviewed manuscript, an international conference presentation, and sustained scholarly collaboration. It also strengthened the mentee's confidence, academic writing, and emerging leadership identity, while expanding the mentor's understanding of global cardiovascular nursing education and leadership needs. Bidirectional learning, intentional goal-setting, and structured support were central mechanisms through which leadership capacity, research productivity, and international networks were enhanced. CONCLUSION:Cross-cultural mentorship programs led by professional societies such as ACNAP can serve as purposeful leadership-development strategies that build research capacity, support health-equity goals through global partnership, and cultivate the next generation of nurse leaders in cardiovascular care.
BACKGROUND:Military nursing operates at the intersection of healthcare and defense, requiring nurses to balance professional ethics with military discipline, operational readiness, and organizational hierarchy. PURPOSE:To explore how military nurses in a small defense system construct and sustain professional identities and how organizational structures and military culture shape their autonomy, competence, well-being, and family life. METHODS:A qualitative design using reflexive thematic analysis was employed. Nineteen individual semistructured interviews were conducted with military nurses serving in the armed forces. DISCUSSION:Seven interrelated themes demonstrated that professional identity in military nursing is dynamic, adaptive, and morally grounded, and is continuously negotiated at the intersection of care and command. Organizational hierarchy, autonomy, professional development, emotional resilience, family responsibilities, and institutional recognition shaped participants' professional experiences. CONCLUSION:Empathetic leadership, realistic training, and policies that support work-life balance and equitable recognition are vital for well-being and operational readiness. Stronger organizational support and clearer leadership communication may enhance retention, resilience, and the quality of military healthcare.
BACKGROUND:There is a high demand for wound care among people who use drugs. PURPOSE:The purpose of our study was to identify difference-making factors that consistently distinguish wound care nurses who practice harm reduction from nurses who do not. METHODS:Data came from a national, cross-sectional survey of 173 wound care nurses conducted from September 2024 to June 2025. The Theory of Planned Behavior and coincidence analysis were applied to pinpoint difference makers for three different outcomes: 1) intention to carry out harm reduction practices; 2) interest in volunteering in-person at a harm reduction organization; and 3) interest in volunteering remotely. DISCUSSION:Factors related to attitudes or norms were each sufficient by themselves for intention to practice harm reduction. Factors related to attitudes or self-efficacy were likewise sufficient on their own for volunteering in-person. Low stigma by itself was both necessary and sufficient for volunteering remotely. CONCLUSIONS:Addressing stigma, attitudes, norms, and self-efficacy can strengthen nurses' ability to deliver ethically grounded, evidence-based care to stigmatized populations.
BACKGROUND:The concept of nursing innovation remains inconsistently defined across the literature. This conceptual ambiguity impedes the advancement of nursing innovation scholarship. PURPOSE:To advance conceptual clarity of nursing innovation within global health ecosystems as a heuristic to support the knowledge base of the nursing discipline. METHODS:The Innovation in NurSIng for Global Health ecosystems Transformation (INSIGHT) study applies Rodgers' evolutionary concept analysis. The search was performed in February 2025 across five databases, supplemented by hand-searching of reference lists. Rodger's core components (attributes, antecedents, consequences, surrogate terms, and related concepts) were identified and analyzed using a hybrid deductive-inductive thematic analysis. The synthesized findings were subsequently interpreted through a nursing philosophical lens. A conceptual model was developed and illustrated through an exemplar of nursing innovation. DISCUSSION:A total of 10,540 records were screened, with 43 articles included. Four defining attributes were identified: innovation characteristics, innovator capabilities, innovation process, and solution dimensions. Antecedents comprised contextual conditions (unmet needs, opportunity identification, and emerging demands) and structural conditions (innovation education, professional capabilities, leadership support, and organizational systems). Consequences included value generation and delivery, as well as unintended consequences. The analysis yielded a proposed definition of nursing innovation. CONCLUSION:As nursing and health systems face unprecedented challenges, a shared understanding of nursing innovation among nursing stakeholders is essential to support the design and implementation of solutions that advance the well-being of individuals, populations, and global health ecosystems. Continued theoretical and empirical inquiry is warranted to further refine this evolving concept and advance nursing innovation scholarship.
Innovative behavior among nurses is essential for improving healthcare quality and efficiency, yet innovation levels remain moderate across clinical settings. While leadership and organizational factors have been widely examined, less is known about how professional values shape innovative behavior, particularly among nurse managers. The purpose of this study was to investigate whether the professional values of entrepreneurship and collaboration are associated with innovative behavior in nurses and whether these relationships vary by managerial role. Data were collected through an anonymous online survey of 127 nurses across diverse healthcare settings. Previously validated measures assessed innovative behavior, professional values, and background characteristics. The Principal Results revealed that innovative behavior was shaped by a significant interaction between managerial role and the values of entrepreneurship and collaboration. Specifically, entrepreneurship was positively associated with innovative behavior primarily when collaboration value was high, and this pattern was more evident among nurse managers. In the full model, managerial role was negatively associated with innovative behavior, suggesting that managerial responsibilities may constrain innovation unless supported by strong entrepreneurial and collaborative value orientations. CONCLUSION: Findings highlight the importance of fostering entrepreneurship and collaboration values in nursing leadership development to strengthen innovation capacity in healthcare organizations.
BACKGROUND:Nurse Practitioner (NP) roles are promoted to address workforce shortages and improve care access. Variation in regulatory authority, financing structures, and system-level integration mechanisms influences how NP roles are implemented across health systems. PURPOSE:To synthesize empirical evidence on how NP roles are regulated and operationalized across policy environments and how regulatory design, financing alignment, and integration mechanisms influence health system contributions. METHODS:A systematic review following PRISMA guidelines was conducted. PubMed, CINAHL, Scopus, and Web of Science were searched for studies published between 2015 and 2025 examining NP regulation, implementation processes, or outcomes. DISCUSSION:Twenty-seven studies met the inclusion criteria, with most evidence originating from the United States and limited representation from other countries. Regulatory liberalization, particularly full practice authority, was associated with improved access indicators, NP presence in shortage areas, and fewer hospitalizations. However, these benefits appeared unlikely to result solely from regulatory reform and instead depended on whether legal authority was supported by integration mechanisms, such as credentialing and privileging, billing and reimbursement, workforce deployment, and organizational governance. CONCLUSION:Policy reforms expanding NP authority should be designed as integrated reform packages rather than stand-alone regulatory changes. Alignment of scope-of-practice authority with credentialing and privileging, billing and reimbursement, workforce deployment, and organizational governance is necessary for legal authority to translate into measurable health system contributions.
BACKGROUND:Nurse scientists are increasingly expected to lead research applying artificial intelligence (AI) to advance health equity. However, there is little published guidance on how to structure and lead the multidisciplinary teams required to meet such work demands. PURPOSE:To describe a replicable team science model for nurse-led AI research, derived from a completed three-year project using AI text analysis to detect stigmatizing language in obstetric electronic health records and its associations with maternal health outcomes. METHODS:We present a case-based analysis of a multidisciplinary project (2022-2025) integrating nursing, data science, epidemiology, obstetrics, and informatics. We describe team structure, workflow, and decision-making across five methodological phases. FINDINGS:Four principles for effective nurse-led AI team science emerged: deliberate role design positioning nurse scientists as intellectual leaders; investment in cross-disciplinary translation infrastructure; operationalization of equity at every stage; and realistic resource and timeline planning. DISCUSSION:This blueprint offers practical guidance for nurse scientists seeking to lead technically complex, equity-focused AI research, arguing that team structure, not technical sophistication, is the most critical determinant of success.
BACKGROUND:The United States maternal health crisis persists as a public health emergency characterized by high mortality rates and stark racial disparities. These disparities reflect structural racism and intersecting social inequities operating simultaneously across multiple systems. PURPOSE:This scoping review maps maternal health innovations implemented in the United States from 2017 to 2025, examining equity integration, implementation approaches, and scalability through structural racism, intersectionality, and RE-AIM frameworks. METHODS:A scoping review was conducted following PRISMA-ScR guidelines and JBI methodology. Systematic searches of PubMed/MEDLINE, CINAHL Plus, PsycINFO, and grey literature were performed from April through August 2025. Two independent reviewers screened records; a third reviewer resolved disagreements. Quality assessment used the Mixed Methods Appraisal Tool. DISCUSSION:Fourteen studies across six categories were identified: Digital Health and Telehealth (n = 4, 29%), Clinical Quality Improvement (n = 2, 14%), Community Workforce Development (n = 2, 14%), Social Determinants of Health (n = 2, 14%), Policy and Payment Reform (n = 2, 14%), and Communication and Mental Health Access (n = 2, 14%). All retrieved innovations incorporated explicit equity considerations targeting Medicaid populations, racial and ethnic minorities, and safety-net communities. Nine innovations (64%) achieved scaled implementation; sustainability was strongest among policy-institutionalized and cost-effective interventions. The equity integration finding reflects characteristics of the equity-focused literature retrieved rather than a field-wide empirical claim. Critical scaling factors include infrastructure capacity, policy alignment, sustainable funding, and demonstrated cost-effectiveness. CONCLUSION:Nurses are positioned to lead equity-centered maternal health innovation and advance the dismantling of structural determinants driving persistent racial disparities in maternal outcomes across the United States.
Background Nursing ethics guides practice, but European Union national codes were developed in diverse socio-legal contexts, generating heterogeneous emphases. Purpose To compare European Union nursing codes of ethics, mapping convergences, divergences, and emerging ethical dimensions. Methods Qualitative documentary analysis with thematic content analysis examined 22 European Union member-state codes plus the European Nursing Council and International Council of Nurses (ICN) codes, with input from nursing, qualitative, and health-law experts. Discussion Fourteen themes were identified: Dignity, Respect and Non-Discrimination; Autonomy and Informed Consent; Professional Secrecy and Data Protection; Safety and Evidence-Based Practice (EBP); Interprofessional Collaboration and Shared Responsibility; Protection of Vulnerable Groups and Violence Prevention; Palliative Care and Dignity at the End of Life; Conscientious Objection and Continuity of Care; Technologies and Artificial Intelligence; Environmental Sustainability and Public Health; Social Justice and Advocacy; Organizational Well-being; Governance, Integrity, and Professional Discipline; Training and Professional Development. Fundamental principles showed strong convergence, while newer areas (AI, One Health, organizational well-being) appeared unevenly. The findings suggest the existence of a shared ethical core across European nursing while highlighting differences in the formalization of emerging ethical challenges. These variations may reflect contextual priorities, regulatory traditions, and different stages of ethical adaptation across national frameworks. Conclusion This study provides an updated overview of the European nursing ethics landscape and may inform future discussions on the evolution of ethical guidance in response to contemporary healthcare challenges while respecting national contexts.
Background In Finland, Nurse Practitioner (NP) role integration remains fragmented amid ongoing health and social care reform. Leadership is a key determinant of role development, yet evidence on how nurse leaders advance NP role integration remains limited. Purpose To examine nurse leaders’ perceptions of NP role integration within Finland’s wellbeing services counties (WSCs). Methods A qualitative descriptive design was used. Data were collected through four focus group interviews with 18 nurse leaders from four WSCs and analyzed using qualitative content analysis. Discussion/Conclusions Successful NP integration requires strong nursing leadership and governance. Although large-scale reforms create opportunities to redesign professional roles and workforce models, integration depends on a clear strategic vision and coordinated leadership across policy, organizational and clinical levels. Even when the value of NP roles is recognized, implementation is likely to remain fragmented unless nursing leaders are actively involved in workforce planning, service development and health policy decision-making.
BACKGROUND:Black transgender women are disproportionately exposed to discrimination and healthcare barriers associated with poor health and delayed treatment-seeking. Consequently, traditional treatment pathways may not be accessible. Thus, health self-management (HSM) may be critical in promoting health among Black transgender women. PURPOSE:The purpose of this study is to examine the relationships among intersectional discrimination, self-efficacy for health management, and mental health outcomes (PTSD symptoms, depressive symptoms, and unhealthy days) among Black transgender women, and to determine whether self-efficacy modifies or explains the association between intersectional discrimination and these health outcomes. METHODS:We analyzed quantitative survey data from a community-based United States sample of 154 Black transgender women to advance our understanding of the associations between intersectional discrimination, self-efficacy to manage one's health, and distal health outcomes. Analyses included Pearson's correlations, T-tests, and multiple linear regression. RESULTS:Higher self-efficacy was associated with better mental health overall but did not consistently buffer the effects of intersectional discrimination, suggesting partial mediation rather than full mediation or moderation. DISCUSSION:Among Black transgender women, racism and cisgenderism may be influencing other components in the pathway between context and health outcomes, contributing to higher self-reported self-efficacy or reducing the potential effect of self-efficacy on health outcomes. CONCLUSION:Future research should further examine the historical and present-day prejudicial systems that affect one's self-efficacy to manage their health and take an anti-cisgenderist and anti-racist approach to discussing HSM with Black transgender women.
BACKGROUND:Wilderness and remote healthcare requires clinicians to deliver high-stakes care amid resource limitations, environmental hazards, and prolonged evacuation timelines. PURPOSE:This exploratory concept review proposes a conceptual framework for post-MSN DNP nursing preparation in austere settings, focusing on role adaptability, clinical decision-making, and training innovations including simulation, telehealth, and mobile diagnostics. METHODS:A targeted literature review (2010-2025) informed the identification of key competency themes across team-based care, education, and safety, though findings are descriptive and intended to guide framework development rather than establish empirical outcomes. DISCUSSION:Role fluidity, rather than discipline-specific hierarchy, consistently defines care delivery, with nurses contributing expertise in patient monitoring, prolonged field care, care coordination, and risk mitigation. Three practice-shaping trends emerge: expanded telehealth for specialist support, simulation-based training for low-frequency high-acuity events, and mobile diagnostics for field decision-making. Key gaps include limited outcome data, inconsistent competency standards, and policy frameworks misaligned with austere practice. CONCLUSION:Standardized competencies, team-based training, and cross-disciplinary outcomes research are recommended as priorities, with anticipated benefits including improved APRN workforce readiness, enhanced interprofessional coordination, and stronger systems-level capacity for remote care delivery.
BACKGROUND:Moral distress is common among critical care nurses providing end-of-life (EOL) care, yet contributing factors are not fully synthesized. PURPOSE:To summarize the literature on factors influencing moral distress in adult ICU nurses delivering EOL care. METHODS:A scoping review of moral distress in adult ICU nurses providing EOL care, published 1984 to 2025, was conducted across five databases. Data on study design and findings were extracted and thematically analyzed. Study quality was assessed using the Mixed Methods Appraisal Tool. DISCUSSION:Moral distress among ICU nurses in EOL care stems from structural, interpersonal, and organizational factors. Key themes include hierarchical power that silences nurses, emotionally charged nurse-family relationships, systemic barriers, and the role of professional development and empowerment in building resilience. The findings suggest shifting focus from individual resilience to organizational and interprofessional strategies targeting root causes. Literature highlights interprofessional discord over nonbeneficial care, inconsistent palliative care integration, and the importance of professional growth in managing moral distress. CONCLUSION:Multi-level factors drive moral distress. Structured training, clear protocols, and supportive policies are essential to support nurses and optimize EOL care.
